scholarly journals Sonographic Assessment of Complex Ultrasound Morphology in Pregnant Women with the Use of IOTA Simple Rules Risk and ADNEX Scoring Systems

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 414
Author(s):  
Artur Czekierdowski ◽  
Norbert Stachowicz ◽  
Agata Smoleń ◽  
Tomasz Kluz ◽  
Tomasz Łoziński ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Risk Model ◽  
Malignant Tumors ◽  
Scoring Systems ◽  
Subjective Assessment ◽  
Risk Level ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Adnexal Masses ◽  
Simple Rules

Background: To evaluate the accuracy of subjective assessment (SA), the International Ovarian Tumor Analysis (IOTA) group Simple Rules Risk (SRR) and the Assessment of Different NEoplasias in the adneXa (ADNEX) model for the preoperative differentiation of adnexal masses in pregnant women. Methods: The study population comprised 36 pregnant women (median age: 28.5 years old, range: 20–42 years old) with a mean gestation age of 13.5 (range: 8–31) weeks at diagnosis. Tumors were prospectively classified by local sonographers as probably benign or probably malignant using SA. Final tumor histological diagnosis was used as the reference standard in all cases. Logistic regression SRR and ADNEX models were used to obtain a risk score for every case. Serum CA125 and human epidydimis protein 4 (HE4) concentrations were also retrieved and the Risk of Ovarian Malignancy Algorithm (ROMA) value was calculated. The calculated predictive values included positive and negative likelihood ratios of ultrasound and biochemical tests. Results: Final histology confirmed 27 benign and 9 malignant (including 2 borderline) masses. The highest sensitivity (89%) and specificity (70%) were found for the subjective tumor assessment. Although no malignancy was classified as benign using the SRR criteria (sensitivity = 100%), the specificity of this scoring system was only 37%. At the cut-off risk level of >20%, the ADNEX model had a sensitivity of 78% and a specificity of 70%. Serum levels of CA125, HE4 and the ROMA risk model correctly identified adnexal malignant tumors with a sensitivity of 67%, 25% and 25%, respectively. Corresponding specificities were 72%, 100% and 100%, respectively. The highest positive and negative likelihood ratios were found for SA (LR+ = 3.0 and LR− = 0.16, respectively). Overall diagnostic accuracy of all predictive methods used in this study were similar (range: 70–75%) except for SRR (53%). Conclusion: Subjective assessment remains the best predictive method in complex adnexal masses found at prenatal ultrasound in pregnant women. For less experienced sonographers, both the SRR and ADNEX scoring systems may be also used for the characterization of such tumors, while serum tumor markers CA125 and HE4, along with the ROMA algorithm appear to be less accurate.

Comparison of the diagnostic performances of the Assessment of Different NEoplasias in the adneXa model, Simple Rules model, and Risk of Malignancy Index for adnexal masses in a gynecological oncology centre  in China

2020 ◽  
Author(s):  
Le Qian ◽  
Qinwen Du ◽  
Meijiao Jiang ◽  
Fei Yuan ◽  
Hui Chen ◽  
...  
Keyword(s):  
Prediction Models ◽  
Roc Curves ◽  
Chinese Patients ◽  
Malignant Tumours ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Adnexal Masses ◽  
Simple Rules ◽  
Risk Of Malignancy ◽  
Risk Of Malignancy Index

Abstract Background This study aimed to compare different ultrasound-based International Ovarian Tumor Analysis (IOTA) prediction models, namely, the Simple Rules (SRs) the Assessment of Different NEoplasias in the adneXa (ADNEX) models, and the Risk of Malignancy Index (RMI), for the pre-operative diagnosis of adnexal mass. Methods This single-centre, retrospective study of diagnostic accuracy involved 486 patients. All ultrasound examinations were analyzed and the prediction models were applied. Pathology was the clinical reference standard. The diagnostic performances of prediction models were measured by evaluating receiver-operating characteristic (ROC) curves, sensitivities, specificities, positive and negative predictive values, positive and negative likelihood ratios, and diagnostic odds ratios. Results To discriminate benign and malignant tumours, areas under the ROC curves (AUCs) for ADNEX models were 0.94 (95% CI: 0.92–0.96) with CA125 and 0.94 (95% CI: 0.91–0.96) without CA125, which were significantly higher than the AUCs for RMI I-III: 0.87 (95% CI: 0.83–0.90), 0.83 (95% CI: 0.80–0.86), and 0.82 (95% CI: 0.78–0.86), (all P < 0.0001). At a cut-off of 10%, the ADNEX model with CA125 had the highest sensitivity (0.93; 95% CI: 0.87–0.97) compared with the other models. The SRs model achieved a sensitivity of 0.93 (95% CI: 0.86–0.97) and a specificity of 0.86 (95% CI: 0.82–0.89) when inconclusive diagnoses (11.7%) were classified as malignant. Conclusion ADNEX and SRs models were excellent at characterising adnexal masses which were superior to the RMI in Chinese patients.

scholarly journals Comparison of the Diagnostic Performances of Ultrasound-Based Models for Predicting Malignancy in Patients With Adnexal Masses

2021 ◽  
Vol 11 ◽  
Author(s):  
Le Qian ◽  
Qinwen Du ◽  
Meijiao Jiang ◽  
Fei Yuan ◽  
Hui Chen ◽  
...  
Keyword(s):  
Prediction Models ◽  
Malignant Tumors ◽  
Roc Curves ◽  
Chinese Patients ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Adnexal Masses ◽  
Risk Of Malignancy ◽  
Risk Of Malignancy Index ◽  
Accuracy Study

AimThis study aimed to compare different ultrasound-based International Ovarian Tumor Analysis (IOTA) prediction models, namely, the Simple Rules (SRs) the Assessment of Different NEoplasias in the adneXa (ADNEX) models, and the Risk of Malignancy Index (RMI), for the pre-operative diagnosis of adnexal mass.MethodsThis single-centre diagnostic accuracy study involved 486 patients. All ultrasound examinations were analyzed and the prediction models were applied. Pathology was the clinical reference standard. The diagnostic performances of prediction models were measured by evaluating receiver-operating characteristic curves, sensitivities, specificities, positive and negative predictive values, positive and negative likelihood ratios, and diagnostic odds ratios.ResultsTo discriminate benign and malignant tumors, areas under the ROC curves (AUCs) for ADNEX models were 0.94 (95% CI: 0.92–0.96) with CA125 and 0.94 (95% CI: 0.91–0.96) without CA125, which were significantly higher than the AUCs for RMI I-III: 0.87 (95% CI: 0.83–0.90), 0.83 (95% CI: 0.80–0.86), and 0.82 (95% CI: 0.78–0.86), (all P &lt; 0.0001). At a cut-off of 10%, the ADNEX model with CA125 had the highest sensitivity (0.93; 95% CI: 0.87–0.97) compared with the other models. The SRs model achieved a sensitivity of 0.93 (95% CI: 0.86–0.97) and a specificity of 0.86 (95% CI: 0.82–0.89) when inconclusive diagnoses (11.7%) were classified as malignant.ConclusionADNEX and SRs models were excellent at characterising adnexal masses which were superior to the RMI in Chinese patients.

scholarly journals External Validation of the IOTA Classification in Women with Ovarian Masses Suspected to Be Endometrioma

2021 ◽  
Vol 10 (13) ◽  
pp. 2971
Author(s):  
Lee Cohen Ben-Meir ◽  
Roy Mashiach ◽  
Vered H. Eisenberg
Keyword(s):  
Expert Opinion ◽  
Transvaginal Ultrasound ◽  
External Validation ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Adnexal Masses ◽  
Tertiary Referral Center ◽  
Surgery Group ◽  
Simple Rules ◽  
Potentially Malignant

The study aimed to perform external validation of the International Ovarian Tumor Analysis (IOTA) classification of adnexal masses as benign or malignant in women with suspected endometrioma. A retrospective study including women referred to an endometriosis tertiary referral center for dedicated transvaginal ultrasound (TVUS). Adnexal masses were evaluated using the IOTA classification simple descriptors, simple rules and expert opinion. The reference standard was definitive histology after mass removal at laparoscopy. In total, 621 women were evaluated and divided into four groups: endometrioma on TVUS and confirmed on surgery (Group 1 = 181), endometrioma on TVUS but other benign cysts on surgery (Group 2 = 9), other cysts on TVUS but endometrioma on surgery (Group 3 = 2), masses classified as other findings or suspicious for malignancy on TVUS and confirmed on surgery (Group 4 = 5 potentially malignant, 11 benign). This gave a sensitivity 98.9%, specificity 64%, positive 95.3% and negative 88.9% predictive values, positive 2.74 and negative 0.02 likelihood ratios and 94.7% overall accuracy. The surgical diagnosis for the five masses suspected to be malignant was: borderline serous tumor (2), borderline mucinous tumor (2), and endometrioid lesion with complex hyperplasia without atypia (1). The conclusions were that the IOTA classification simple descriptors, simple rules and expert opinion performs well for classifying adnexal masses suspected to be endometrioma. The most common potentially malignant masses in these women were borderline ovarian tumors.

scholarly journals Endoscopist’s Judgment Is as Useful as Risk Scores for Predicting Outcome in Peptic Ulcer Bleeding: A Multicenter Study

2020 ◽  
Vol 9 (2) ◽  
pp. 408
Author(s):  
Enric Brullet ◽  
Pilar Garcia-Iglesias ◽  
Xavier Calvet ◽  
Michel Papo ◽  
Montserrat Planella ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Roc Curve ◽  
Clinical Judgment ◽  
Scoring Systems ◽  
Subjective Assessment ◽  
Risk Scores ◽  
Ulcer Bleeding ◽  
Operating Characteristics ◽  
Peptic Ulcer Bleeding ◽  
Predictive Values

Background: Guidelines recommend using prognostic scales for risk stratification in patients with non-variceal upper gastrointestinal bleeding. It remains unclear whether risk scores offer greater accuracy than clinical evaluation. Objective: Compare the diagnostic accuracy of the endoscopist’s judgment against different risk-scoring systems (Rockall, Glasgow–Blatchford, Baylor and the Cedars–Sinai scores) for predicting outcomes in peptic ulcer bleeding (PUB). Methods: Between February 2006 and April 2010 we prospectively recruited 401 patients with peptic ulcer bleeding; 225 received endoscopic treatment. The endoscopist recorded his/her subjective assessment (“endoscopist judgment”) of the risk of rebleeding and death immediately after endoscopy for each patient. Independent evaluators calculated the different scores. Area under the receiver-operating-characteristics (ROC) curve, sensitivity, specificity, positive and negative predictive values were calculated for rebleeding and mortality. Results: The areas under ROC curve of the endoscopist’s clinical judgment for rebleeding (0.67–0.75) and mortality (0.84–0.9) were similar or even superior to the different risk scores in both the whole group and in patients receiving endoscopic therapy. Conclusions: The accuracy of the currently available risk scores for predicting rebleeding and mortality in PUB patients was moderate and not superior to the endoscopist’s judgment. More precise prognostic scales are needed.

scholarly journals Protein:Creatinine Ratio in Random Urine Samples Is a Reliable Marker of Increased 24-Hour Protein Excretion in Hospitalized Women with Hypertensive Disorders of Pregnancy

2007 ◽  
Vol 53 (9) ◽  
pp. 1623-1628 ◽  
Author(s):  
Alfredo Leaños-Miranda ◽  
Janeth Márquez-Acosta ◽  
Fernando Romero-Arauz ◽  
Guadalupe M Cárdenas-Mondragón ◽  
Roxana Rivera-Leaños ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Cross Sectional Study ◽  
Urine Samples ◽  
Likelihood Ratios ◽  
Cross Sectional ◽  
Predictive Values ◽  
Protein Excretion ◽  
Significant Difference ◽  
Before And After ◽  
H Protein

Abstract Background: The protein:creatinine ratio in random, untimed urine samples correlates with 24-h protein excretion in pregnant women with and without hypertension. Nevertheless, whether this ratio is appropriate as a screening test for proteinuria is still unclear, in part because of the paucity of large studies. Methods: We measured protein:creatinine ratios in random urine samples and protein contents of 24-h urine samples in a cross-sectional study of 927 hospitalized pregnant women at ≥20-weeks of gestational age and in a 2nd cohort of 161 pregnant women. In the 2nd group, urine specimens were obtained before and after completion of the 24-h collections, avoiding 1st-morning void specimens. Results: Protein excretion was ≥300 mg/24 h in 282 patients (30.4%). The urine protein:creatinine ratio and the 24-h protein excretion were significantly correlated (r = 0.98, P &lt;0.001). The protein:creatinine ratio as an indicator of protein excretion ≥300 mg/24 h was ≥0.3. The sensitivity and specificity were 98.2% and 98.8%, respectively. Positive and negative predictive values were 97.2% and 99.2%, respectively, and positive and negative likelihood ratios were 79.2 and 0.02, respectively. The diagnostic accuracy of the urinary protein:creatinine ratio was corroborated in the 2nd cohort of patients, which also showed no statistically significant difference in protein:creatinine ratio between samples obtained &gt;24 h apart. Conclusions: Random urinary protein:creatinine ratio is a reliable indicator of significant proteinuria (&gt;300 mg/day) in nonambulatory pregnant women, irrespective of sampling time during the daytime. The protein:creatinine ratio may be reasonably used as an alternative to the 24-h urine collection method.

scholarly journals Risk assessment of preterm birth through identification and stratification of pregnancies using a real-time scoring algorithm

2021 ◽  
Vol 9 ◽  
pp. 205031212098672
Author(s):  
Lisa BE Shields ◽  
Clayton Weymouth ◽  
Kevin L Bramer ◽  
Scott Robinson ◽  
Donna McGee ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Real Time ◽  
First Trimester ◽  
Operating Characteristics ◽  
Early Care ◽  
Likelihood Ratios ◽  
Third Trimester ◽  
Predictive Values ◽  
Scoring Algorithm

Introduction: Preterm birth poses a significant challenge. This study evaluated a real-time scoring algorithm to identify and stratify pregnancies to indicate preterm birth. Methods: All claims data of pregnant women were reviewed between 1 January 2014 and 31 October 2018 in Kentucky. Results: A total of 29,166 unique women who were matched to a live newborn were documented, with the pregnancy identified during the first trimester in 54.1% of women. Negative predictive values, sensitivity, and positive likelihood ratios increased from the first to third trimesters as pregnant women who were matched to a live newborn had more visits with their physicians. The area under the receiving-operating characteristics curve on test data classifying preterm birth was 0.59 for pregnancies identified during the first trimester, 0.62 for pregnancies identified in the second trimester, and 0.73 for pregnancies identified in the third trimester. Conclusions: This study presents a real-time scoring algorithm of indicating preterm birth in the first trimester of gestation which permits stratification of pregnancies to provide more efficient early care management.

scholarly journals Indirect comparison of TIMI, HEART and GRACE for predicting major cardiovascular events in patients admitted to the emergency department with acute chest pain: a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e048356
Author(s):  
Jun Ke ◽  
Yiwei chen ◽  
Xiaoping Wang ◽  
Zhiyong Wu ◽  
Feng Chen
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Cardiovascular Events ◽  
Indirect Comparison ◽  
Acute Chest Pain ◽  
Scoring Systems ◽  
Cochrane Library ◽  
Major Adverse Cardiovascular Events ◽  
Likelihood Ratios ◽  
Predictive Values

BackgroundThe study aimed to compare the predictive values of the thrombolysis in myocardial infarction (TIMI); History, Electrocardiography, Age, Risk factors and Troponin (HEART) and Global Registry in Acute Coronary Events (GRACE) scoring systems for major adverse cardiovascular events (MACEs) in acute chest pain (ACP) patients admitted to the emergency department (ED).MethodsWe systematically searched PubMed, Embase and the Cochrane Library from their inception to June 2020; we compared the following parameters: sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic OR (DOR) and area under the receiver operating characteristic curves (AUC).ResultsThe pooled sensitivity and specificity for TIMI, HEART and GRACE were 0.95 and 0.36, 0.96 and 0.50, and 0.78 and 0.56, respectively. The pooled PLR and NLR for TIMI, HEART and GRACE were 1.49 and 0.13, 1.94 and 0.08, and 1.77 and 0.40, respectively. The pooled DOR for TIMI, HEART and GRACE was 9.18, 17.92 and 4.00, respectively. The AUC for TIMI, HEART and GRACE was 0.80, 0.80 and 0.70, respectively. Finally, the results of indirect comparison suggested the superiority of values of TIMI and HEART to those of GRACE for predicting MACEs, while there were no significant differences between TIMI and HEART for predicting MACEs.ConclusionsTIMI and HEART were superior to GRACE for predicting MACE risk in ACP patients admitted to the ED.

Threat of premature birth: psycho-social aspects

2016 ◽  
pp. 86-89
Author(s):  
S. Zhuk ◽  
◽  
O. Schurevska ◽  
Keyword(s):  
Pregnant Women ◽  
Physical Functioning ◽  
Premature Birth ◽  
Defense Mechanisms ◽  
Subjective Evaluation ◽  
Clinical Signs ◽  
Subjective Assessment ◽  
Psychological Status ◽  
Stress Load ◽  
Mandatory Participation

The objective: to study the psychological characteristics of women’s status in one of the most common complications of pregnancy - the threat of termination of pregnancy, depending on the level of stress load. Patients and methods. We have studied the psychological status (the Holmes-Rahe level of psychosocial stress, the Spielberg-Hanin level of anxiety, V.I.Dobryakov’s related to a pregnancy test, diagnosis of psychological defense mechanisms, assessment of quality of life) 60 pregnant women with threat of premature birth in the third trimester of pregnancy. Surveyed women were divided into 2 groups: group 1 included 30 pregnant women – forced migrant of Donetsk and Lugansk area and 2 group – 30 pregnant women who resided in Kiev. Results. At the same clinical picture of the threat of premature birth we detected discrepancy between the subjective assessment of their condition in women – forced migrants: a high level of situational and personal anxiety, decrease in physical (physical functioning, role-physical functioning) and psychological (social functioning, role emotional functioning) health, doubtful and pathological subtypes of gestational dominant. This creates prerequisites for complications of pregnancy, childbirth and postpartum future period and requires the participation of psychologists in the work with this category of patients. Conclusion. So, revealed a discrepancy between the objective clinical signs similar obstetric pathology (on the example of threatened abortion) in pregnant women with different levels of stress load and their subjective evaluation of their condition that affects their psychological status. This should be reflected in individually tailored therapy and be mainstreamed into the work of obstetricians and gynecologists with these patients, and requires mandatory participation of psychologists in the work with this category of patients. Key words: pregnancy, the threat of premature birth, stress, psychological status.

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